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RS3PE revisited: a systematic review and meta-analysis of 331 cases
P. Karmacharya1, A.A. Donato2, M.R. Aryal3, S. Ghimire4, R. Pathak5, K. Shah6, P. Shrestha7, D. Poudel8, T. Wasser9, A. Subedi10, S. Giri11, L. Jalota12, A. Olivé13
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA. paraskarmacharya@gmail.com
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA.
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA.
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA.
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA.
- Department of Internal Medicine, Mymensingh Medical College, Mymensingh, Bangladesh.
- Department of Internal Medicine, Nanjing Medical University, Nanjing, Jiangsu, China.
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA.
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA.
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
- Department of Pulmonology and Critical Care, University of California, San Francisco, CA, USA.
- Rheumathology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
CER8636
2016 Vol.34, N°3
PI 0404, PF 0415
Full Papers
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PMID: 27050250 [PubMed]
Received: 25/05/2015
Accepted : 29/09/2015
In Press: 25/03/2016
Published: 30/05/2016
Abstract
OBJECTIVES:
Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome is a rare inflammatory arthritis, characterised by symmetrical distal synovitis, pitting oedema of the hands and feet, absence of rheumatoid factor, and favourable response to glucocorticoids. The aim of our study is to further delineate the clinical and laboratory features, and response to treatment.
METHODS:
We performed a systematic electronic search of Medline, PubMed, EMBASE, ACR and EULAR databases for case reports, case series, and related articles of RS3PE. Statistical analysis was done comparing categorical variables with Chi-square tests and frequencies of means via t-tests. Binary logistic regression analysis was performed to identify predictors of erosions, recurrence, malignancy and rheumatologic disorders.
RESULTS:
331 cases of RS3PE were identified from 121 articles. RS3PE was found in older patients (71±10.42 years) predominantly in males (n= 211, 63.36%), was symmetrical (n=297/311, 95.50%) involved the hands (n=294/311, 94.53%) A concurrent rheumatologic condition was reported in 22 cases (6.65%), and malignancy in 54 cases (16.31%). Radiographic joint erosions were found in 5.5%. Most patients responded to medium-dose glucocorticoids (16.12±9.5 mg/day). Patients with concurrent malignancy requiring non-significantly higher doses of prednisone (18.12 vs. 15.76 mg, p 0.304) and higher likelihood of recurrence of disease (OR 4.04, 95% CI 1.10–14.88, p=0.03).
CONCLUSIONS:
The symptoms and unique findings that make up RS3PE appear to represent a steroid-responsive disease that may be a harbinger of an underlying malignancy. More study is needed to understand the molecular origins of RS3PE in order to determine whether it is a separate disease process. Patients with concurrent cancer tend to have more severe presentations and higher rates of recurrence.
